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Definition
Vaginal prolapse is the inward and downward bulging of the vaginal walls. It occurs when the supporting tissues of the lower pelvis weaken. The lack of support causes the walls of the vagina walls to collapse. Other structures or organs near the vagina are also shifted. Types of vaginal prolapse include:
- Cystocele (dropped bladder)when the collapse involves the front of the vagina and bladder
- Rectocelewhen the collapse involves the back of the vagina and rectum
- Enterocelewhen the collapse involves the top vaginal wall and small bowel
The severity of vaginal prolapse may be simply defined as:
- First degreea collapse into the upper part of the vagina
- Second degreecollapse further into the vaginal canal
- Third degreea collapse that reaches the vaginal opening or extends beyond the opening
There are more sophisticated ways of measuring and describing prolapses. Specialist physicians will use them.
Causes
Vaginal prolapse is caused by weakened support structures in the pelvic region. Support tissue includes fascia (a fibrous tissue), ligaments, and muscles.
Pelvic Floor Muscles and Organs
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Risk Factors The following factors increase your chance of developing vaginal prolapse: Vaginal childbirthMultiple birthsProlonged laborGiving birth to a large babyMenopauseAdvancing ageObesityChronic coughingSmoking Chronic constipation Symptoms Vaginal prolapse may not cause any symptoms. But when it does, the symptoms may include: Vaginal pressureA feeling of vaginal fullness or heavinessA feeling of pulling in the pelvisDiscomfort in the vaginaLow backache that is relieved with lying downUrinary frequencyUrination when laughing, coughing, or exercisingDifficulty with bowel movementsPainful intercourse DiagnosisYour doctor will ask about your symptoms and medical history, and perform a physical exam. Vaginal prolapse that has no symptoms may be diagnosed during routine gynecologic examinations. Your doctor may refer you to a gynecologist, who will perform a pelvic exam. TreatmentTalk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include: Kegel ExercisesKegel exercises consist of a conscious effort to squeeze the pelvic muscles. It should feel like you were trying to prevent urination. Each squeeze (contraction) of the muscles should be held for 10 seconds, and then relaxed. Repeat a total of ten times for each exercise period. The entire routine should be repeated four times per day.
Pessary InsertionYour doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. SurgeryVaginal prolapse that is severe or associated with lasting symptoms may require surgery. Surgery, called pelvic reconstruction, usually includes colporrhaphy and perhaps hysterectomy. Colporrhaphy is the surgical repair of the pelvic support structures. The vagina is also sutured to a stable structure to suspend it. Prevention To help prevent vaginal prolapse: Do Kegel exercises regularly, especially before and after childbirth. Avoid constipation.Maintain a healthy weight. If you smoke, quit. Smoking may cause chronic coughing and weakening of connective tissues. Limit heavy lifting.Avoid birth canal trauma at childbirth. RESOURCES: American College of Obstetricians and Gynecologistshttp://www.acog.org/ National Women's Health Information Centerhttp://www.4woman.gov/ CANADIAN RESOURCES: Canadian Women's Health Networkhttp://www.cwhn.ca/indexeng.html Society of Obstetricians and Gynaecologists of Canadahttp://www.sogc.org/ References: Uterine prolapse. EBSCO Health Library website.Available at: http://healthlibrary.epnet.com/GetContent.aspx?token=da29d243-e573-4601-8b42-77cd0ccb14b2&chunkiid=11477.Accessed February 28, 2007.
Uterine and vaginal prolapse. Merck website. Available at: http://www.merck.com/mmpe/sec18/ch250/ch250c.html. Accessed February 28, 2007. Vaginal prolapse. Cleveland Clinic website. Available at: http://cms.clevelandclinic.org/urology/body.cfm?id=117. Accessed February 28, 2007. Last reviewed March 2008 by Ganson Purcell Jr., MD, FACOG, FACPEPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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